Disclosure Statement Regarding Criminal Plea/Conviction

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DISCLOSURE STATEMENT

Please complete one form for each plea or conviction, regardless of when the crime was committed or whether it was dismissed or expunged. All fields must be completed. FAILURE TO ACCURATELY REPORT ANY AND ALL DISCLOSABLE PLEAS/CONVICTIONS MAY BE GROUNDS FOR THE DENIAL OF YOUR APPLICATION.

This is an easy-fill form that will walk you through the process to fully and accurately complete this form. Upon completion, you will be required to print and submit the document to CSLB.

IMPORTANT NOTES:

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Make sure you give yourself enough time to complete the entire form in one sitting. You will not be able to save a partially filled form to complete at a later time.


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APPLICANT AND PLEA/CONVICTION INFORMATION

* Required Entry

*PLEA/CONVICTION LEVEL: *PLEA/CONVICTION LEVEL:
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SENTENCE INFORMATION

* Required Entry

Please describe any punishment imposed by the court.
*WERE YOU INCARCERATED?
 








 
Pane 3

PROBATION/PAROLE INFORMATION

* Required Entry

*WERE YOU PUT ON PROBATION OR PAROLE?
 

*HAVE THE ABOVE FINES BEEN PAID IN FULL?
*HAS THE ABOVE RESTITUTION BEEN PAID IN FULL?
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CRIME AND REHABILITATION INFORMATION

* Required Entry

Please provide details of this crime, including a complete description of the facts and circumstances that led to your plea/conviction. You should include who participated in the crime; who the victim was; what losses were suffered; and when, where, and how the crime occurred.
What positive changes have you made in your life since this conviction? Please attach documentation to support any rehabilitation efforts.
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Review and Edit

Please Review the Following Information

This is a summary of the information that will print on your form. If there are any corrections that need to be made, please choose the Edit button or Back button below to make the change now, as you will not have the opportunity to do so after you submit this page.

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Completion Instructions

NOTICE: This document is not submitted to or saved by CSLB. You must either print it now, save it to your computer, or email it to your email address to print and mail at a later time.

Mail your document(s) along with the application to:


Contractors State License Board
P. O. Box 26000
Sacramento, CA 95826

PDF

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This process does not save or submit your document to CSLB. If you email the document to your email address, you will still need to follow the instructions to print and mail it to CSLB.

Finished

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